NO PERMIT NUMBER (5) 5825 BO�.T,TNGER R0
Building Permit Confirnked..4E�-�
./ Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
Date.,--".�...-l,�l'..�..-------------- 197 . Permit No......�L..s-- . .. /--------------- ,
The undersigned hereby makes application to the Plumbing Inspector of the City of San Jose
for a' permit to install plumbing fixtures and/or pipes listed on the reverse side.
Exemption from requirement for State of California for Contractor's License is hereby claimed
by undersigned: as owner ❑ statement filed
Undersigned attests that his State of California Contractor's License # 3-28322
is in full force and effect and properly authorizes this application.
San Jose City Business License #�7_ ✓G `G '
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER L f,71/EQq,v e//4"EC It
ADDRESS ;S"8 5 Bu &/N G -A'2 IQ R Lot No.
USE OF BUILDING S c/yi u L
Signed .s7�O �. . Cr.Kt.lt: f- -=iL✓glTinajVl6j�
280-.,401n
5825 BOLLINGER ROAD FRANK. CIARI PLUMBING
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